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Fresson, M. et al (2017). The Role of Self-Transcendence and Cognitive
Processes in the Response Expectancy Effect. Psychologica Belgica,
57(1), pp. 77–92, DOI: https://doi.org/10.5334/pb.364
RESEARCH ARTICLE
The Role of Self-Transcendence and
Cognitive Processes in the Response
Expectancy Effect
Megan Fresson, Benoit Dardenne, Marie Geurten, Laury Anzaldi and
Thierry Meulemans
Neuropsychological assessment is known to be influenced by expectancy effects,
which can either enhance (placebo) or diminish (nocebo) cognitive performance.
Research suggests that the response expectancy effect is influenced by various
individual and situational factors and that the placebo effect results in an increase
in monitoring processes as measured indirectly. However, the impact on ­monitoring
processes has not yet been studied by direct measures such as Judgement Of
Learning (JOL). This study aimed to investigate the response expectancy effect on
various neuropsychological tasks, including a task that directly assesses ­monitoring
capacities (JOL). In addition to determining which cognitive functions are influenced by the expectancy effect, this study examined the moderating role of the
self-transcendence dimension of personality. Eighty healthy subjects were exposed
to three bogus conditions presented as allegedly having a positive, negative, or
no impact on cognitive capacities. Then they completed, in random order, three
blocks of tasks (executive, attentional, and memory), one in each condition. Results
showed an effect of negative instructions on flexibility (poorer ­performance) and
memory (better performance) scores. Furthermore, positive instructions led to
better explicit monitoring capacities (JOL) than the neutral condition. These
effects were moderated by self-transcendence, as only participants with moderate
or high self-transcendence exhibited these effects. Overall, our results showed
that the response expectancy effect emerges from a combination of individual and
cognitive factors.
Keywords: Response expectancy; Placebo; Nocebo; Neuropsychology;
­Self-transcendence; Monitoring
Psychology and Neuroscience of Cognition
(Research Unit), University of Liège, Liège, BE
Corresponding author: Megan Fresson
([email protected])
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Response Expectancy Effect
Introduction
Neuropsychological performance is ­generally
not a perfect reflection of the individual’s cognitive potential. Indeed, n
­ europsychological
test performance is influenced by a multitude of factors, such as motivation, mood
state (e.g., anxiety), fatigue, pain, etc. (Arnett,
2013). One of these secondary influences is
the phenomenon of response expectancy:
in response to particular stimuli, people
may expect a specific (cognitive, emotional,
physiological, etc.) effect, which then might
actually occur as a consequence of the expectation (Kirsch, 1997).
Historically, the response expectancy effect
has been examined in pharmacological and
medical studies, through the placebo effect.
The placebo effect refers to cases in which
an individual expects an improvement in
health or performance related to an inactive
intervention that is described as beneficial,
and experiences an actual beneficial effect
associated with this positive expectation
(Stewart-Williams & Podd, 2004). The placebo effect has its counterpart, called the
nocebo effect, which refers to the negative
effect resulting from negative expectations.
The placebo-design paradigm permits one to
examine the effect of a substance or a device,
while controlling for expectancy effects.
Additionally, in the field of psychology, the
impact of response expectancy on cognitive
performance has yielded intriguing results.
For example, Magalhães De Saldanha da
Gama, Slama, Caspar, Gevers, and Cleeremans
(2013) showed that the conflict resolution
effect produced by the Stroop task can be
moderated in response to a placebo suggestion wherein an inactive EEG cap is described
as triggering a brain wave that influences
color perception. Healthy participants who
were told that the brain wave would impair
their visual perception did indeed show more
interference compared to baseline, while the
opposite effect was observed for people told
that the device would improve their visual
capacities.
While some studies (Colagiuri, Livesey,
& Harris, 2011; Magalhães De Saldanha da
Gama et al., 2013) showed both nocebo and
placebo effects on cognitive performance,
other studies either observed an impact of
only one of the two phenomena or investigated only one of them. For example, Oken
et al. (2008) showed a placebo effect on
memory, inhibition, and choice reaction
time tasks for people receiving a pill that was
supposed to improve their cognitive functioning (compared to the control group),
but did not investigate the nocebo effect.
In a study by Kvavilashvili and Ellis (1999),
participants received an inactive substance
presented as either a memory-enhancing
pill (placebo group) or a memory-impairing
pill (nocebo group). The results showed that,
while participants in both groups perceived
cognitive changes in the expected direction – an enhancement in the placebo group
and an impairment in the nocebo group –
a response expectancy effect on objective
memory performance was observed only in
the nocebo group: participants who were
given the “memory-impairing” pill performed worse on memory tasks.
In sum, while some studies have shown
a clear effect of both positive and negative
expectancy manipulations on cognitive performance (e.g., Magalhães De Saldanha da
Gama et al., 2013; Colagiuri et al., 2011),
other studies have found conflicting results.
One study demonstrated a placebo effect on
cognitive self-assessment but not on objective cognitive tasks (Kvavilashvili & Ellis,
1999), another showed expectancy effects
in some tasks but not in others (Oken et al.,
2008), and one found nocebo effects but no
placebo effects (Kvavilashvili & Ellis, 1999).
These diverse findings do not call the existence of response expectancy effects themselves into question, but they do suggest
that placebo and nocebo effects are complex
phenomena emerging from a combination
of situational and individual factors that
can moderate the effect of the experimental
placebo/nocebo instructions.
In this regard, some studies have tried to
identify a placebo responder personality by
examining different aspects of personality
Fresson et al: The Role of Self-Transcendence and Cognitive Processes in the
Response Expectancy Effect
such as optimism (Geers, Helfer, Kosbab,
Weiland, & Landry, 2005; Geers, Kosbab,
Helfer, Weiland, & Wellman, 2007; Morton,
Watson, El-Deredy, & Jones, 2009) or
­neuroticism (Darragh, Booth, & Consedine,
2014; Pecina et al., 2013). In these studies,
the dependent variable consisted mostly of
subjective reports of changes in emotional
state, pain, comfort, etc. To our knowledge,
no study has yet examined personality moderators of response expectancy on objective cognitive performance. In our study,
we focused specifically on the personality dimension of self-transcendence (ST;
Cloninger, 1999) which has received growing interest in different psychology fields
for several years now (Garcia-Romeu, 2010).
ST is defined as “the self-forgetful awareness
that all objects are integral participants in
the evolution of all that is as a whole, giving
coherence and joy to all things” (Cloninger,
1999a, p. 177). Three characteristics define
people who are high in ST: a tendency to
be absorbed when doing activities (people
appear “absent minded”); a feeling of strong
connectedness with the universe (and with
nature) and other people; a propensity to
spirituality including religion, belief in extrasensory experiences or telepathy (see also
MacDonald & Holland, 2002).
Interestingly, some studies showed
that ST was linked to greater response to
­hypnotic suggestion. Cardeña and Terhune
(2014) showed that participants who scored
higher on ST reported higher perception
of the announced changes suggested by
the ­hypnotic suggestion (see also Laidlaw,
Dwivedi, Naito, & Gruzelier, 2005). So, some
studies have already shown that people high
in ST could be especially susceptible to expectancies (in this case, expectancies induced
by hypnotic suggestion). Moreover, the
proposed role of self-transcendence in the
expectancy effect on cognitive performance
makes sense when one considers research by
Hyland and collaborators (Hyland, Geraghty,
Joy, & Turner, 2006; Hyland & Whalley,
2008; Hyland, Whalley, & Geraghty, 2007).
These authors examined the link between
79
the placebo effect on subjective symptoms
(e.g. related to sleep quality) and spirituality, a personality trait that includes a dimension of transcendence. They found that this
link depended on the type of therapy used
(Hyland & Whalley, 2008; Hyland et al.,
2007) and that spirituality, which involves
two main dimensions – it “(a) includes a
reference to transcendence or the sacred…
and (b) emphasises an individual connection
with transcendence, others, and the world in
general,…” (Saroglou & Muñoz-García, 2008,
p. 88) – was in some cases a dispositional
predictor of placebo effects.
Regarding these results, ST could influence
individuals’ response to placebo/nocebo
instructions, and therefore moderate the
expectancy effect. Indeed, high-ST individuals
are prone to accept situations c­ haracterized
by uncertainty and ambiguity and without any possibility of control; according
to Cloninger (1999a), this is why they are
often perceived as naïve. Because they are
more likely to be absorbed in experience, to
believe in supernatural, to feel connectedness with the environment, and to have a
propensity for spirituality (Cloninger, 1999a;
MacDonald & Holland, 2002), high-ST individuals could possibly be more prone to
response expectancy effects than low-ST
individuals. To our knowledge, no study has
examined the moderating impact of ST on
expectancy effects, nor – more generally –
personality predictors of expectancy effects
on cognitive performance, leaving the way
open for further investigations.
Finally, another variable that could explain
the unsystematic nature of the expectancy
effect relates to the kinds of cognitive processes measured. Some cognitive functions
may be more prone to produce expectancy effects than others. In this regard,
the ­stereotype threat phenomenon (Steele
& Aronson, 1995) reveals that reminding
participants about a negative stereotype
(e.g. “women are bad in math”) induces
poor ­
performance in targeted individuals.
Because s­tereotype threat can be seen as
a particular instance of the nocebo effect
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Fresson et al: The Role of Self-Transcendence and Cognitive Processes in the
Response Expectancy Effect
(i.e., reduction in performance that might
be explained by ­negative expectancy effects
induced by the activation of the stereotype),
this ­
literature could be helpful in understanding what kinds of cognitive processes
are more susceptible to expectancy effects.
Several authors have precisely shown that
the negative expectancy induced by social
representations is most likely to impact tasks
that tap the most into executive processes,
i.e. high-level cognitive processes which permit regulation during goal-directed actions
(Croizet et al., 2004; Dardenne et al., 2013;
Schmader & Johns, 2003; Schmader, Johns,
& Forbes, 2008).
Consequently, it may be that nocebo conditions lead to underperformance in tasks
that recruit mainly executive processes,
while the placebo condition might lead to
improvements in the same tasks. The results
obtained by Oken et al. (2008) partially
support this hypothesis as they observed
a ­placebo effect on almost all tasks known
to tap executive processes (delayed recall
tasks, inhibition task, and multiple reaction
time task), although there were no improvements in working memory and fluency tasks,
which are also known to involve executive
processes. In the expectancy effect literature,
only a few studies (e.g., Looby & Earleywine,
2011; Oken et al., 2008; Sun, Zhang, He, Liu,
& Miao, 2007) have examined the impact of
experimental instructions on a set of cognitive tasks administered during the same session. In our view, it would be interesting to
study the differential impact of expectancy
effects on a series of cognitive tasks that differ according to the relative involvement of
executive processes.
In line with this executive hypothesis,
previous studies have also shown that
­
placebo instructions lead subjects to rely
­
more on controlled strategic processes.
In these ­
studies, it has been argued that
the fact that participants spent more time
reading misleading items in a memory task
(Parker, Garry, Engle, Harper, & Clifasefi,
2008) and completing the primary task in a
dual task condition (Parker, Garry, Einstein,
& McDaniel, 2011) reflects the intervention
of metacognitive processes. The allocation
of more time to complete tasks is traditionally viewed as an indirect measure revealing the use of controlled strategic processes
(Dunlosky & Metcalfe, 2009). However, this
proxy measure does not allow us to be sure
that metacognitive processes are being
assessed in this way. To be certain of this,
more direct measures of metacognition
should be used. Traditionally, direct metacognitive processes are assessed by asking
participants to judge their mental cognitive
states while they carry out the task, an ability
that is usually called metacognitive monitoring. During a memory task, a classic procedure for appraising these cognitive states
consists in asking participants to judge the
quality of their learning (judgement of learning; JOL) (Dunlosky & Metcalfe, 2009). In
this context, there is reason to assume that
response expectancy instructions would also
affect the accuracy of participants’ metacognitive judgements, as assessed through a JOL
procedure.
Overview of the Present Study
In this study, our main goal was to investigate
the expectancy effect (nocebo and placebo)
on cognitive performance. More specifically,
we aimed to study the moderating role of
the self-transcendence dimension of personality on the placebo and nocebo effects on
cognitive tasks. A second aim of this study
was to examine which cognitive processes
are impacted by the expectancy effect. To
test this, participants were asked to complete cognitive baseline tasks to ensure for
cognitive equivalence between groups, then
to face three conditions (nocebo, neutral,
and placebo) under which they completed
attentional, memory, or executive tasks. Each
participant undertook all tasks in random
order and under randomized conditions
(see below). Finally, participants completed
a measure of perceived changes in cognitive functioning and a scale assessing ST.
We hypothesized (1) that expectancy effects
would be greatest for high-ST participants;
Fresson et al: The Role of Self-Transcendence and Cognitive Processes in the
Response Expectancy Effect
(2) that tasks that call on executive ­processes
(executive and memory tasks) would be preferentially negatively impacted by nocebo
instructions and positively impacted by
placebo instructions; (3) that placebo
­
instructions would lead to better monitoring
as evaluated by JOL, while nocebo instructions would lead to worse JOL accuracy, that
is, inaccurate judgement of learning.
Method
Participants
Eighty healthy participants took part in this
study. They were recruited on the campus
of the University of Liège (Belgium). People
were invited to participate in a study that
allegedly investigated the impact of light
on cognition. Potential participants were
excluded if they reported a past or present
neurological, developmental, or ­psychiatric
disorder. Participants’ ages ranged from
18 to 30 years, with a mean age of 22.71
(SD = 3.11) years; years of education ranged
from 9 to 21, with a mean education level of
13.44 (SD = 2.20) years; and 52.5% of the
participants were female. Age and education
level were controlled such that they were
statistically equivalent (ps > .217) between
experimental conditions (see below).
Material
The information letter indicated that the
university lab was carrying out multiple
experiments on the effects of light on cognition. It was explained that human eyes
accommodate to the illumination level;
some levels of illumination have no effect
on cognition (below 1000 lux), but at higher
levels (ranging from 1000 to 7000 lux) light
has a beneficial effect on cognition because
rhodopsin and nerve impulses are optimally
stimulated. It was also explained that, above
this level of illumination (higher than 7000
lux), light has a depleting impact on cognition because rhodopsin, and therefore nerve
impulses, are over-stimulated. This letter also
informed participants that they would not
be able to perceive the difference between
lamps because the lamps impacted cognition
81
by subtle chemical messages and nerve
impulses. Of course, information about the
lamps was totally misleading. Finally, in each
case, participants were asked to keep the
kind of lamp a secret from the examiner,
supposedly so the examiner would remain
unbiased.
To make the supposed experimental
basis of the study appear more credible, we
used three lamps with electric devices (e.g.,
a ­dimmer), and a label (patent for lamps)
on their bases. In reality, these lamps had
exactly the same electrical properties. Every
lamp had the same bulb and an audible
device that was briefly activated by the experimenter while switching on the lamp. Each
lamp was accompanied by an information
card that briefly described its anticipated
effects. Information for the placebo (nocebo)
lamp was: “You will be exposed to the lamp
which improves (diminishes) and stimulates
(inhibits) attentional and memory capacities.
With this light, people feel a sensation of ease
(being swamped) while completing memory
and concentration tasks. People are more
(less) alert, concentrate better (worse), find
it easy (difficult) to memorize things, work
faster (slower), and become tired less (more)
quickly. Thus, exposure to this lamp will have
a positive (negative) effect on your memory
and your concentration. Don’t forget that
you must not tell the experimenter the content of this information.” Information on the
neutral lamp was exactly the same, except
that it explained that the lamp had no effect
on the various capacities mentioned.
Cognitive baseline tasks
These tasks, which differed from the tasks
of interest (dependent variables), were
administered prior to any expectancy
­
instructions (i.e., without any lighted
­
­experimental lamp), to statistically control
for prior i­nter-individual cognitive differences in analyses of expectancy effects.
Computerized adaptation of the visual
memory span subtest of the Wechsler Memory
Scale – Revised (WMS-R; Wechsler, 1987).
In this computerized task created with
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Fresson et al: The Role of Self-Transcendence and Cognitive Processes in the
Response Expectancy Effect
Toolbook software (version 11.0, SumTotal
Systems Inc., Gainesville, FL), there are eight
blue squares on the screen which turn red
in a particular sequence. The participant’s
task is to reproduce the opposite sequence
by mouse-clicking on the squares. The length
of the sequences increases until participants
fail on three items of the same sequence
length.
Stroop task (Godefroy & GREFEX, 2008).
This task, originally designed by Stroop
(1935), is composed of three subtasks: a
color naming subtask in which participants
have to name the colors of rectangles as
quickly as ­possible; a word reading subtask
in which participants have to read color
names as quickly as possible; and a color
word n
­ aming subtask in which participants
have to name the print color of color words
(e.g., red ­written in blue) as quickly as possible, ­resisting the interference produced by
the automatic tendency to read.
Experimental tasks
Participants completed three blocks (an executive block, a memory block, and an attention
block), each comprising two tasks measuring either executive, memory or attentional
functioning. Each block was administered
following the experimental instructions
and with the participant facing one of the
three experimental lamps. Participants were
exposed to each condition (lamps) and completed one of the three blocks under it. The
order of the tasks within each block is presented below.
Executive block
We selected two tasks known to tax
­executive resources (i.e., a switching and a
go/no-go paradigm) and to recruit primarily
prefrontal areas (Collette & Van der Linden,
2002; Niendam et al., 2012). According to the
executive hypothesis concerning the social
negative expectancy effect, we expected
these tasks to be affected by our experimental instructions.
Go/No-go subtest of the Test of Attentional
Performance (TAP; Zimmermann & Fimm,
2010). In this computerized inhibition task,
two kinds of crosses (+ and X) rapidly appear
on the screen one at a time. Participants have
to press the response button as quickly as
possible only when the X appears.
Flexibility subtest of the TAP (Zimmermann
& Fimm, 2010). In this computerized flexibility task, a letter and a digit appear simultaneously on the screen, with their position
changing randomly (left or right side of the
screen). Participants have to respond with
one of two response buttons (left or right).
They must alternate as quickly as possible
between pressing the button corresponding to the location of the letter for one item,
and then pressing the button corresponding
to the location of the digit for the following
item, and so on. Since a trend toward alternating between left and right hands becomes
pronounced during the task, items requiring
participants to press the same ­button twice
(68 out of a total of 100 items) tax executive
processes because they require the on-going
(and therefore dominant) response of alternating between left and right hands to be
inhibited.
Memory block
The following memory tasks are known to
recruit not only memory processes but also
executive resources. Delayed word recall
involves executive functioning (Fletcher,
Shallice, & Dolan, 1998), and the SelfOrdered-Pointing-Test (SOPT) is a working
memory task calling on executive resources
(Bryan & Luszcz, 2001). According to the literature on social negative expectations and
previous expectancy effect studies showing
the impact of placebo/nocebo instructions
on memory performance, these tasks may be
influenced by experimental conditions.
Self-Ordered Pointing Test (SOPT; Petrides
& Milner, 1982). In this computerized working memory task created in Toolbook 11.0,
abstract symbols are displayed on the screen,
and the participants’ task is to move the
mouse over each symbol. But each time participants select a symbol, the location of all
the symbols changes. Therefore, participants
Fresson et al: The Role of Self-Transcendence and Cognitive Processes in the
Response Expectancy Effect
have to remember which symbols they have
already selected. There are five series (4, 5, 6,
8, and 10 symbols) of two groups with the
same symbols: the second group requires
participants to begin with a different s­ ymbol
than the first one and therefore recruits
more executive processes (Geurten, Catale, &
Meulemans, 2015a).
Word pair memory task (Froger, Bouazzaoui,
Isingrini, & Taconnat, 2012). This memory
task created in E-Prime software 2.0 was
adapted from the experimental task used
by Froger et al. (2012). During the learning
phase of our task, 30 word pairs are randomly
displayed on the screen one by one for an
indefinite period of time (until participants
press the space bar), as the learning phase is
self-paced. During this learning phase, after
each word pair, participants are encouraged
to state aloud a judgement of learning (JOL),
indicating their confidence in their capacity to recall this word pair later, on a scale
ranging from 0% to 100%. During the cuedrecall phase (after a delay of approximately
10 ­minutes filled with a non-verbal cognitive
task, the SOPT), the first word of each pair
is individually displayed on the screen in
­random order, and the participant’s task is to
recall the associated word.
Attention block
The following attentional tasks rely heavily
on processing speed and less on controlled
processes (Van Zomeren & Brouwer, 1994).
We therefore expected that these tasks would
not be influenced by expectancy effects.
Shortened version of the vigilance subtest
of the TAP (Zimmermann & Fimm, 2010). In
this vigilance task created in E-Prime software (version 2.0, Psychology Software Tools,
Inc., Sharpsburg, PA), two adjacent rectangles
remain on the screen and become grey one
at a time. Occasionally, though, this alternation sequence is broken; when that happens,
participants have to press the space bar as
quickly as possible.
D2 test (Brickenkamp, 1998). In this paperand-pencil processing speed task, participants have to cancel out “D2” signs (letter
83
D with exactly two dashes located below
and/or above it) dispersed among distractors
(letter D with fewer or more than two dashes
and letter P with any number of dashes).
Participants have to process 14 lines of P’s
and D’s, for which 20 seconds are allocated
per line.
Questionnaires
Perceived effect questionnaire. This 6-item
scale (Cronbach’s α = .88) was specifically
created for this experiment but no validation
studies were conducted. This scale requires
participants to respond to statements regarding their perception of the effect of the lamps
(e.g., “I do not think the lamps had the anticipated effect”) using a 5-point Likert scale
ranging from “totally disagree” to “totally
agree,” with a “neutral” midpoint. (The questionnaire is presented in Appendix A).
Self-transcendence
subscale
of
the
Temperament and Character Inventory –
Revised (TCI-R) (Cloninger, 1999b). This
26-item scale (Cronbach’s α = .84) evaluates
the self-transcendence dimension of personality and is a subscale extracted from the TCI-R
of Cloninger (1999b). The TCI-R has been
developed from the psychobiological model
of temperament and character (Cloninger,
Svrakic, & Przybeck, 1993). This subscale
assesses the three facets of ST described in
the introduction section: the tendency to
absorption (“creative self-forgetfulness”), the
sense of strong connection with the universe
as a whole (“transpersonal identification”),
and the propensity to spirituality (“spiritual acceptance”). Participants respond on
a 5-point Likert scale (ranging from “totally
false” to “totally true”), indicating how well
each statement describes them. The French
version of the TCI-R has shown good psychometric characteristics (Hansenne, Delhez, &
Cloninger, 2005).
Measures and data reduction
From both theoretical conceptualizations
and simple bivariate correlations between
scores on tests, we computed composite
scores in order to reduce the number of
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Fresson et al: The Role of Self-Transcendence and Cognitive Processes in the
Response Expectancy Effect
dependent variables. We created a ­composite
attention score by averaging the attention
index of the D2 test (total number of correctly treated D2 items minus total number
of errors) and the median reaction time of the
vigilance task (reversed) (r = .26, p = .021).
A composite memory score was created by
averaging Z-scores for the number of correctly recalled words during the delayed
recall of the word pair memory task and the
total number of errors of the SOPT (reversed)
(r = .31, p = .005). For the accuracy of JOL during the word pair memory task, gamma correlations were calculated for each subject’s
JOL and their actual word recall. In this case,
the higher the correlation, the more accurate
the JOL. Regarding executive functions, since
the total number of errors on the go/no-go
subtest (“Inhibition score”), and the total
number of correct responses (CR) for items
without a hand change (“Flexibility score”)
were not correlated (r = –.13, p = .267), we
performed statistical analysis on each one
separately.
For the cognitive baseline tasks, we selected
the following measures: total number of
errors for the color word naming subtest of
the Stroop task (“Stroop interference”), completion time for the color naming subtask
of the Stroop task (“Stroop color”), and total
number of correctly answered items in the
visual span subtest (“Span score”).
Procedure
The experiment took place either in a
­university lab or at the participant’s home
(63.8% of participants took part in this
study at home).1 After participants gave
their ­
written consent, sociodemographic
information was collected (age and years of
­education), and participants completed the
two cognitive baseline tasks. Then, they read
a letter informing them that the goal of the
study was to test the effect of three experimental lamps that had differential effects on
cognition (positive, negative, or no effect).
Next, each participant was exposed to each
lamp – all of which were actually identical – while completing the tasks. There
were three blocks, each comprising two
tasks: ­executive tasks, attentional tasks, and
memory tasks. Each block was performed
with a different lamp, with the order of
lamps and blocks being totally randomized
(e.g., participant A completed the executive
block thirdly facing the nocebo lamp while
participant B completed the executive block
first, and facing the neutral lamp). As such,
this between-subject design was created following the Latin square procedure. Before
presenting each block of tasks, the experimenter switched off the room light and
switched on the experimental lamp. Each
experimental lamp was accompanied by an
envelope containing information regarding
the lamp’s effect, which participants were
invited to read silently. Thus, the experimenter remained blind to the condition.
Between lamp conditions, the experimenter
switched on the room light, telling participants that their retinas had to readapt to
the room light before being exposed to the
next lamp. After completing all task blocks,
participants filled in a perceived effect questionnaire and the self-transcendence subscale of the TCI-R (Cloninger, 1999b). Finally,
they were debriefed on the real purpose of
the study.
Results
Statistical analyses were performed using
SPSS.
Perceived Effect of Lamps
We created an index of perceived effect by
averaging the 6 items of the scale. Higher
scores represent a tendency to feel the
anticipated effects of the different lamps.
Descriptive statistics showed that 41% of
participants obtained a mean score between
1 and 3, inclusively (M = 2.35, SD = 0.52),
suggesting that they did not feel the effects
of the lamps. However, 59% of participants obtained a score above 3 (M = 3.67,
SD = 0.30), indicating that they felt the
lamps’ effects. Interestingly, there was a positive correlation between perceived effect of
lamps and ST (r = .25, p = .025).
Fresson et al: The Role of Self-Transcendence and Cognitive Processes in the
Response Expectancy Effect
Moderation Analyses
Since we were interested in understanding
for which participants expectancy effects
impact cognitive performance, we chose to
conduct moderation analyses. The goal of
moderation analyses is to examine whether
the size or the sign of the effect of one variable (X; expectancy instructions) on another
(Y; cognitive score) is conditioned by (or
depends on) one or more other variables
(M; ST). To test our hypothesis regarding
the moderating role of ST, we followed the
regression-based approach recommended by
Hayes (2013). This approach enabled us to
study the conditional effects (i.e., the effect
of X on Y depending on M) of experimental
conditions on each dependent variable while
keeping the ST moderator under the continuous metric (rather than dichotomizing ST).
In other words, it enabled us to examine if
there was an impact of expectancy instructions for all individuals or only for high-ST
participants. We therefore expected an interaction between expectancy instructions and
ST. To do so, we used Hayes’ (2013) PROCESS
computational tools.
Due to our multi-categorical independent
variable,2 we used orthogonal contrasts to
test the nocebo effect and the placebo effect
separately in regression analyses (Brauer
& McClelland, 2005; Davis, 2010; Judd,
McClelland, Ryan, Muller, & Yzerbyt, 2010).
On the one hand, when examining the
nocebo effect, the independent variable was
the nocebo contrast (the nocebo condition
contrast-coded +1/2 and the neutral condition contrast-coded –1/2) and we controlled
for (as covariate) the associated orthogonal
contrast (the nocebo and the neutral condition contrast-coded –2/3 and the placebo
condition +2/3) and its interaction with
ST. On the other hand, when analyzing the
placebo effect, the independent variable
was the Placebo contrast (the ­placebo condition contrast-coded +1/2 and the n
­ eutral
condition contrast-coded –1/2) and we
controlled for the associated orthogonal
contrast (the placebo and the neutral conditions contrast-coded –2/3 and the nocebo
85
condition +2/3) and its interaction with ST.
By doing this, we conserved the same sum
of squares. Consequently, for each dependent variable, we conducted an ordinary least
squares regression in which the cognitive
score was estimated from the nocebo or
placebo contrast, ST, and their interaction,
while controlling for the cognitive baseline
performance and the associated orthogonal
contrast (as well as its interaction with ST).
In these analyses, ST was mean-centered.
Therefore, the b coefficient for experimental condition, for instance, indicates the
conditional effect of condition when ST was
at its mean value. Finally, regarding cognitive baseline performance, we controlled for
Stroop interference when analyzing executive tasks; Stroop color for the attentional
score; and Span score for the memory score
and JOL accuracy.
Executive tasks
Flexibility score
There was no significant effect of the
Stroop interference covariate (p = .892).
There was a significant effect of ST
(b = –1.99, SE = .76, t = –2.62, p = .011).
Regarding the placebo condition, there
was no effect of placebo contrast or interaction between placebo contrast and ST
(ps > .493). However, at the mean value
of ST, there was a significant effect of
nocebo contrast (b = –1.96, SE = .94,
t = –2.09, p = .040). More interestingly, as
predicted, the interaction between nocebo
contrast and ST was significant (b = –5.04,
SE = 2.02, t = –2.50, p = .015). To probe
this interaction, we used the pick-a-point
approach, which creates two values of
the ST score: low ST (one standard deviation below the mean) and high ST (one
standard deviation above the mean). The
results showed that there was a nocebo
effect only for high (b = –4.58, SE = 1.44,
t = –3.18, p = .002) ST individuals, who
produced fewer correct responses than
their counterparts in the neutral condition. There was no effect of condition for
low-ST participants (p = .626).
86
Fresson et al: The Role of Self-Transcendence and Cognitive Processes in the
Response Expectancy Effect
Inhibition score
There was no significant effect or interaction
on the inhibition score (ps > .175).
Attention tasks
Composite attention score
Apart from a significant effect of the Stroop
color covariate (b = –.04, SE = .01, t = –4.32,
p < .000) on the Attention score, there were
no other significant effects or interactions
(ps > .119).
Memory tasks
Composite memory score
There was a significant effect of the Span score
covariate (b = .13, SE = .04, t = 3.19, p = .002)
on the memory score, but no effect of ST or
placebo contrast, or interaction between placebo contrast and ST (ps > .244). As well, at
the mean value of ST, there was no effect of
nocebo contrast (p = .106). However, there
was a trend toward an interaction between
nocebo contrast and ST (b = .73, SE = .38,
t = 1.95, p = .055). When this interaction was
probed, the results showed that there was
an effect of the nocebo instructions only
for high-ST participants (b = .72, SE = .28,
t = 2.55, p = .013), who performed better than
their counterparts in the neutral condition.
There was no effect of nocebo condition for
low-ST participants (p = .888).
Accuracy of JOL
There was a significant effect of the Span
score covariate (b = –.06, SE = .02, t = –3.99,
p < .000), but no effect of ST (p = .131) and
nocebo contrast (p = .242). As well, there was
no significant interaction between nocebo
contrast and ST (p = .872). However, there
was a significant effect of placebo contrast
(b = .19, SE = .08, t = 2.34, p = .022), indicating better JOL accuracy in the placebo condition than in the neutral one at the mean
value of ST. The three-way interaction was not
significant (b = .04, SE = .16, t = .27, p = .789).
However, we carried out specific contrasts
to test our hypothesis that a placebo effect
would be found only for high-ST participants. Simple effects showed that there was
a placebo effect for high-ST (b = .21, SE = .11,
t = 1.85, p = .069) participants, but not for
low-ST participants (p = .156).
In sum, the results indicated no effect of
expectancy instructions on the attention
score or on the inhibition task. Regarding
the flexibility score (executive task), no placebo effect was found. However, we observed
a decrease of performance for moderate- and
high-ST participants in the nocebo condition
compared to the neutral one. Regarding the
memory score, there was no effect of placebo
instructions, but an unexpected effect of
nocebo instructions for high-ST participants:
they scored better in the nocebo condition
compared to the neutral condition. Finally,
there was no effect of nocebo instructions
on the JOL accuracy, but a placebo effect
for moderate- and high-ST participants: they
scored better following placebo instructions
compared to the neutral ones.
Discussion
As hypothesized, the ST personality dimension moderated participants’ responses
to experimental instructions, with only
moderate- and high-ST participants exhib­
iting improved or decreased performance
following experimental instructions. As
expected, our experimental instructions had
no impact on attentional tasks but did have
an impact on executive and memory tasks.
Indeed, nocebo instructions led (moderateand) high-ST participants to perform worse
on the flexibility task but, unexpectedly, better on memory tasks. Furthermore, we found
that placebo instructions led to more accurate judgements of learning, compared to
the neutral condition.
Influence of ST
As predicted, ST moderated the impact of
the expectancy effect on cognitive performance. Nocebo instructions had an effect
on the flexibility (impaired performance)
and memory (improved performance)
scores and a placebo effect on JOL but only
for m
­oderate- and high-ST participants.
Concerning the moderating role of ST, as
expected, the higher participants’ ST was, the
worse they performed on a flexibility task
Fresson et al: The Role of Self-Transcendence and Cognitive Processes in the
Response Expectancy Effect
following the nocebo instructions and the
better they judged their learning following
placebo instructions. Unexpectedly, high-ST
participants got better memory scores in the
nocebo condition than in the neutral condition. Finally, the higher participants were
on ST, the more they reported having felt
the expected changes facing the lamps. Our
results are consequently in accordance with
the results of Cardeña and Terhune (2014)
who showed that higher ST is associated with
higher experiential hypnotic suggestibility.
As well, our results are in accordance with
Hyland and Whalley (2008) who showed
that in a spiritual context, spirituality –
which includes ST dimension – moderates
the expectancy effect on subjective reports.
These results and our findings could imply
that a strong feeling of ST predisposes individuals to expectancy effects.
People high in ST are characterized by
three facets (Cloninger, 1999a). The creative self-forgetfulness facet describes high
ST individuals as having a tendency to
absorption. Absorption – defined as a “disposition for having episodes of “total” attention that fully engage one’s representational
(i.e., perceptual, enactive, imaginative, and
ideational) resources” (Tellegen & Atkinson,
1974, p. 268) – has been found to be positively linked to both hypnotic suggestibility
and self-transcendence (Cardeña & Terhune,
2014). Then, in our study, participants high
in ST could have been especially susceptible
to expectancy effects because they did not
question the purpose of the experiment and
were truly committed to it. Secondly, the
transpersonal identification facet describes
high ST individuals as feeling deep union
with the Universe, including the physical
environment. Because people high in ST perceive themselves as a part of a whole, they
could have been especially receptive to the
idea that the environment (i.e. the lamps)
could affect them and modify their experiences. The third facet – spiritual acceptance – characterizes individuals high in ST as
believing in extrasensory experiences as well
as other spiritual influences like ­telepathy.
And, spirituality has been found in some
87
cases to predispose individuals to placebo
effects (Hyland & Whalley, 2008). Their willingness to accept and believe in spiritual or
extrasensory experiences could also have led
high-ST participants to be especially swayed
by our experimental instructions. Due to the
present sample size, we could not afford to
study specifically these different dimensions.
Subsequent studies should therefore focus
on the specific facets of self-transcendence
to better understand its role in the expectancy effect.
An Executive vs. Difficulty-based Account
of the Nocebo effect
According to several authors (e.g., Schmader
et al., 2008), the social negative expectations
effect, which is a specific case of the nocebo
effect, preferentially impacts executive functions. Our results are partially consistent with
this hypothesis. Indeed, there was no effect
on tasks that minimally tap executive processes (attentional tasks), but there was an
effect on the flexibility task and an effect on
memory tasks, although in the unexpected
direction. However, nocebo instructions had
no effect on the inhibition task. In fact, the
inhibition task appears to be too easy: participants made a mean of 0.65 errors, and 48
out of the 80 participants made no errors at
all. While it does recruit executive resources,
this task may not have been sensitive (floor
effect) for our participants, who were composed principally of university students (no
inter-individual variability).
While, as expected, the nocebo instructions had a deleterious impact on the flexibility score, they were associated with an
improvement in memory performance.
These two tasks, however, are not equally difficult. As a matter of fact, several studies in
the stereotype threat literature have shown
that task difficulty strongly moderates the
impact of negative expectancy (e.g., Neuville
& Croizet, 2007; O’Brien & Crandall, 2003).
In these studies, following stereotype threat
instructions, participants’ performance was
found to decrease in complex tasks, while
it improved in simpler tasks. This difficultybased account could explain the differential
88
Fresson et al: The Role of Self-Transcendence and Cognitive Processes in the
Response Expectancy Effect
effect of the nocebo instructions on the
flexibility task (poorer performance) and
the memory tasks (better performance).
Indeed, the memory tasks were self-paced
while the flexibility task involves time pressure. Since there was no time limit during
the memory tasks, high-ST participants –
who were committed to the experiment
– may have improved their performance
following nocebo instructions. For example,
they may have been more cautious (taking
more time) due to the nocebo instructions.
Consequently, they produced fewer errors.
This strategy could not be applied in the flexibility task because of the time pressure.
To sum up, nocebo effects on neuropsychological tasks may have been determined
not only by the kinds of cognitive processes
involved (executive vs. non-executive), but
also by the complexity of the tasks. However,
this explanation should be investigated
more systematically, for example by varying
the level of difficulty (simple vs. complex)
within the same task (executive vs. nonexecutive). Furthermore, we think that not
only objective difficulty but also – in fact,
primarily – perceived difficulty plays a major
role in producing the expectancy effect (e.g.,
Schuster, Martiny, & Schmader, 2015). If individuals find a task difficult in a nocebo condition, this perceived difficulty may reinforce
the experiment’s credibility and therefore
the nocebo effect, in a vicious circle.
Placebo Effect: Impact on Metacognitive
Processes, but not on Cognitive
Performance
Using indirect measures of monitoring, Parker
et al. (2011) and Parker et al. (2008) showed
that placebo instructions lead to better metacognitive processes. A secondary goal of our
study was to investigate the expectancy effect
on a direct measure of monitoring, namely
judgement of learning. Our results showed
that there was a placebo effect for moderate- and high-ST participants; that is, they
assessed their own performance on the task
more accurately than their counterparts in
the neutral condition. Therefore, inducing
positive expectancies led ­
participants to
­better assess their cognitive state while completing a memory task. Our results suggest
that placebo conditions lead to better monitoring strategies. To our knowledge, this is
the first study to show a placebo effect on a
direct measurement of monitoring.
Although participants assessed their
memory performance better in the placebo
condition, placebo instructions did not lead
to improvement in memory performance
or executive tasks. This kind of result has
been observed elsewhere. For example,
Looby and Earleywine (2011) showed that
placebo instructions impact subjective
assessment but have no effect on objective
performance. As well, Kvavilashvili and Ellis
(1999) observed a nocebo effect on objective
and subjective assessment of memory, while
their placebo instructions only affected the
subjective assessment of memory (not objective performance). Therefore, in the cognitive domain, the placebo effect appears not
to systematically mirror the nocebo effect
and to preferentially trigger changes in subjective assessment.
Another explanation could relate to the
fact that we selected a lamp as our response
expectancy object in order to use an object
about which participants would have no a
priori expectations regarding its effect on
cognition. However, response magnitude
could have differed between the nocebo
and placebo effects (limited to subjective assessment) because the cognitiveenhancing characteristic of light (placebo
instructions) was perceived as less powerful
than the cognitive-impairing instructions.
Unfortunately, our design prevented us from
disentangling the perceived effects of the
­placebo lamp from those of the nocebo lamp.
Conclusions
Our study showed that nocebo instructions lead to a decrease in flexibility and an
increase in memory performance. To the best
of our knowledge, this is the first study to
show an effect of placebo instructions on a
direct measure of cognitive control, namely
Fresson et al: The Role of Self-Transcendence and Cognitive Processes in the
Response Expectancy Effect
the accuracy of judgements of learning.
These response expectancy effects appeared
to be moderated by self-transcendence. This
study also confirms the very complex nature
of the mechanisms involved in expectancy
effects, suggesting that some specific conditions are required for the effects to occur.
Our study is a first step in identifying and
disentangling the factors that might influence the appearance of placebo/nocebo
effects on cognitive functioning, as well as
the expectancy effect on higher-order cognitive functions (i.e., metacognitive processes).
As such, our study may also enrich the literature on stereotype and benevolent threats in
helping to understand which specific cognitive functions these threats can impair.
Notes
1In cases where participants took part
in the study at home, the experimenter
brought the material (including lamps)
with her. The experiment was conducted in a silent and isolated room of
the participants’ house. Because some
authors suggest that the location of
the experiment can influence expectancy effects (Parker et al., 2008), we
were interested in its moderating role.
However, too few participants agreed to
take part in the study at the lab (due to
geographical constraints). We therefore
omitted this variable in order to avoid
type I errors due to minimal effective size
in some cells (self-transcendence X lab X
condition). Nevertheless, we verified that
this variable did not influence statistical
results by entering it as a covariate. Since
the pattern of results stayed exactly the
same, we disregarded this variable in the
results section of this experiment.
2In regression analyses, a categorical predictor with more than two levels should
not be entered as a metric variable (in
this study, this would lead to: Nocebo
coded –1; Neutral coded 0; and Placebo
coded +1). This would consist of applying
an arbitrary linear relationship between
levels of a non-ordinal variable (see Judd
89
et al. 2010). This is why we use orthogonal
contrast in this study. These orthogonal
contrasts permit to directly test for group
mean differences. Contrary to the omnibus test with several degrees of freedom,
it then permits to test specific hypotheses
(see Brauer & McClelland, 2005).
Additional File
The additional file for this article can be
found as follows:
• Appendix. Perceived effect questionnaire. DOI: https://doi.org/10.5334/
pb.364.s1
Acknowledgements
This work was supported by the Belgian Fund
for Scientific Research (F.R.S.-FNRS).
Competing Interests
The authors have no competing interests to
declare.
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How to cite this article: Fresson, M., Dardenne, B., Geurten, M., Anzaldi, L. & Meulemans, T. (2017).
The Role of Self-Transcendence and Cognitive Processes in the Response Expectancy Effect.
Psychologica Belgica, 57(1), pp. 77–92, DOI: https://doi.org/10.5334/pb.364
Submitted: 03 October 2016 Accepted: 10 March 2017 Published: 26 June 2017
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